Amplifying Black Brilliance Program Registration

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Amplifying Black Brilliance celebrates the richness of heritage within the African diaspora through creative expression, cultural appreciation, education, and mentorship! This is a free community program hosted by Bristol Riverside Theatre’s Education Department in partnership with No Longer Bound and the African American Historical and Cultural Society of Bucks County. Youth dive into the heartbeat of communication and music through one of the oldest surviving African American objects. The African drum. Further sparking learning, the African American Historical and Cultural Society of Bucks County has curated books for children participating in Amplifying Black Brilliance. In acting classes, learners create monologues inspired by their research of influential Black Americans in history.

With the wisdom and guidance of Louise Davis, program participants examine the life and courage of one of America’s greatest heroes, Harriet Tubman. Ms. Davis is a descendant of Harriet Tubman and trailblazer of African American history & culture. On March 18th youth will celebrate by presenting a showcase to the community!

Start Date: February 1, 2022-March 18
Students will meet every Tuesday and Thursday for seven weeks
Time: 4:30pm-6:30pm
Showcase day: Friday, March 18th, Time TBD
Registration deadline: Jan 20, 2022
Address: 5616 Fleetwing DR, Levittown PA 19057

Please complete one registration form for each student.

Parent's email address *

Student's email address

Student's First Name *

Student's Last Name *

Address *

City *

State

Zip Code *

Contact Number During Program *

Student's Date of Birth *

YYYY

Gender *

Please fill in your Gender

Shirt size *

Current School *

Select your School District *

Bensalem Township

Bristol Borough

Bristol Township

Council Rock

Neshaminy

Pennsbury

Other:

Age *

5-11

12-14

15-17

18-20

Race *

Asian

Black

Native Hawaiian and Other Pacific Islander

More Than One Race

White

Prefer not to say

Ethnicity *

Hispanic or Latino

Not Hispanic or Latino

Prefer not to say

Household Income *

Less than $20,000

$20,000 - $44,999

$45,000 - $64,999

$65,000 or higher

Emergency Contact (Name and relationship) *

Emergency Contact (Number) *

Special Needs/Allergies:

Are there any activities your child cannot participate in due to physical or religious reasons? If yes, please explain.

Does your child have permission to walk home after the program? *

Yes

I hereby release No Longer Bound, Bucks County Housing Authority, Bristol Riverside Theatre and The African American Historical and Cultural Society of Bucks County employees/and consultants from all liability for personal injury. Permission is given to No Longer Bound, Bucks County Housing Authority, Bristol Riverside Theatre and The African American Historical and Cultural Society of Bucks County to bring my child to the hospital emergency room or doctor to obtain medical treatment if necessary. I understand that the highest priority of No Longer Bound, Bucks County Housing Authority Bristol Riverside Theatre and The African American Historical and Cultural Society of Bucks County, is the safety and well-being of the student and staff. From time-to-time there may be situations of circumstances, which, in the opinion of the Program Staff/Bucks County Housing Authority, Bristol Riverside Theatre and The African American Historical and Cultural Society of Bucks County, are not safe, nor are they suitable for the well-being of students and staff. Therefore, staff reserves the right to make decisions about enrollment and participation in activities and programs. *

I consent to the statements above.

I do not consent to the statements above.

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